Product Guide: Insulin Pumps
Find the right device for you
To find an insulin pump that’ll suit you best, it’s a good idea to do more than browse a brochure, call the first pump sales representative you’re referred to, or blindly order the pump your friend or health care provider uses. Given that most people stay with an insulin pump for the length of its warranty (about four or five years), it’s best to treat the devices as long-lasting, big-ticket items. Not only that, but each pump has its own set of advantages and drawbacks. That’s why it’s important to look at the complete package when comparing devices.
But keep in mind: It is unlikely that you will find one pump that is perfectly suited to all of your wants and needs. Just like choosing a house or a car, selecting a pump requires you to take some of the bad with (hopefully) a lot of the good. The key is to find a device that meets most of your important needs, with minimal drawbacks on features that are relevant to you.
Before you can find a pump that meets your most pressing needs, you have to know what you’re looking for. There are several key features that just about everyone should consider when selecting a pump. These include:
There are two ways to wear a pump: directly on the skin or with the device linked to your skin via flexible tubing. Devices with tubing to connect the pump to the body generally offer full programming on the pump itself, a choice of infusion set types, and the opportunity to disconnect from the pump at the infusion site. The tangle factor of the tubing causes some poeople to prefer pods or patch pumps. A “patch” or “pod” pump stays stuck to you until you change it for a new one.
The OmniPod, the only programmable tubing-free pump on the market, offers several advantages: It’s discreet (small enough to hide under clothing), disposable, inserts its own cannula automatically, and eliminates the catching and pulling hassles associated with tubing. Because there’s no tube to fill, the pod doesn’t waste as much insulin. And because it stays on the body continuously, the pod doesn’t cause gaps in insulin delivery due to disconnection. Another bonus: There’s no unwanted movement of insulin when the pump is raised or lowered—something that can occur when using tubing, giving you a small amount of extra insulin when the pump is raised and a bit less than intended when it’s lowered. On the downside, use of a pod-type pump requires a separate remote control for all programming, and any skin- or insertion site–related issues require complete pod replacement.
Most pump users benefit from a device that holds enough insulin for at least three days, plus an extra 20 to 30 units for priming the tubing. If you use less than 60 units (basal and bolus total, or total daily dose) each day, reservoir size isn’t an issue—reservoirs need to be only partially filled. But if you’re insulin resistant or require more than 60 units per day, look for a pump that holds at least 300 units. One pump, Tandem’s T:flex, holds up to 480 units.
Although health insurance usually covers the cost of insulin pumps and disposable supplies, there are often copays and deductibles that must be met. The up-front cost of the OmniPod is approximately 80 to 90 percent less than that of a traditional tubed pump, but the long-term costs can be higher given the higher price for the disposable pods. And keep in mind: Some health plans (including Medicare) don’t cover the OmniPod. If you’re looking to save out of pocket, check out the Roche Accu-Chek Combo, which costs about 20 percent less than other tubed pumps.
An insulin-to-carb ratio will tell you how many grams of carbohydrate a single unit of insulin covers. The ability to calculate bolus doses using insulin-to-carb ratios in tenths of a gram is important for people who require large doses (where each unit of insulin covers 6 grams of carb or fewer). For example, 1 unit of insulin for every 3.5 grams of carb may be needed if 1 unit for every 3 grams is too much but 1 unit for every 4 grams is too little. If that’s you, check out pumps by Tandem, Medtronic, and Roche. Tandem also permits bolus doses as high as 60 units with its T:flex model.
Some pumps allow users to specify a time representing insulin duration—how long after bolus delivery insulin remains active and available in the body. Insulin duration affects calculations of insulin on board, a fancy pump term for the insulin still active in the body after a bolus delivery. Tandem pumps allow insulin duration to be set to the nearest minute while Medtronic pumps allow duration to be set in 30-minute increments.
Tandem pumps also permit the greatest flexibility when setting temporary basal rates, with increases of up to 250 percent for up to 72 hours. They also allow users to set up secondary programs (called “profiles”) with unique basal and bolus settings combined into the same program. Doing so can help users tailor insulin doses during times when they’re more or less sensitive to insulin—say, when they’re sick, stressed out, or exercising more or less than usual. Other pumps allow secondary basal programs, but not secondary bolus programs.
People who are extremely sensitive to insulin and require doses of less than 1 unit may value pumps that allow basal and bolus dosing in the smallest possible increments. Tandem pumps offer basal dosing in increments of 0.001 units and boluses in increments of 0.01 units. Both Animas and Medtronic offer pumps with basal dosing in 0.025-unit increments, and Medtronic pumps allow for boluses in increments of 0.025 units.
If you spend a fair amount of time in or around water, you may want to consider a pump that will not be easily damaged by splashing or submersion. Animas’ pumps are truly watertight—and warranted as such. The OmniPod and Accu-Chek Combo are watertight, but their remote controls are not. Tandem pumps are semi-watertight, while Medtronic pumps are not watertight.
Some pumps eliminate the need to carry a separate CGM receiver by displaying sensor data on the pump screen. The MiniMed 530G has a built-in Medtronic CGM display while the Animas Vibe and Tandem T:slim G4 both have Dexcom CGM integration.
Some pumps accept data transmissions from blood glucose meters. This eliminates the need to manually enter blood glucose values into a pump’s bolus calculator and ensures that the correct reading is always entered. Medtronic pumps link with Ascensia Diabetes Care’s Contour Next Link meter. A handful of pumps have meters integrated into the remote controls that program the pump: The Animas Ping (but not the Animas Vibe) has a OneTouch Ping meter remote, the Accu-Chek Combo’s remote has an Accu-Chek Combo meter, and the OmniPod has a built-in FreeStyle meter.
A pump’s ability to take readings from a CGM and automatically adjust insulin delivery is considered the next great step in diabetes management. Although still in its infancy, the first commercial step toward an artificial pancreas exists in Medtronic’s MiniMed 530G pump. This pump automatically responds to low glucose by suspending basal insulin delivery for up to two hours when low glucose alarms are ignored. Although not intended as a treatment for hypoglycemia (rapid-acting carbohydrate will raise the blood glucose much faster), this feature can provide an extra level of safety and security for those who are susceptible to severe lows.
You’ve read about pump features. The next step: Compare pumps against one another to find out which rate highest on those particular features. You can do that in one of two ways—check them out below.
1. SCAN THE LIST
You’ve read about the top features and learned which pumps offer them. Now find out more about those pumps by downloading this chart. We’ve listed the important data and specs for easy viewing. Scan for our handy icons to find pumps with your favorite features.
2. RUN THE NUMBERS
If you’re not put off by a little bit of math, a good approach to pump comparison is to do a weighted evaluation.
Step 1: Choose the two or three features that are most important to you and assign them an “importance score” from 1 to 5, with 1 being “not at all important” and 5 being “can’t live without it.”
Step 2: On a scale of 1 to 5, rate how well each pump meets your needs with those features.
Step 3: Multiply your importance scores by your ratings. Those are your weighted scores.
Step 4: Add a pump’s weighted scores for all features to get your total score.
For example, let’s say you place extremely high importance on cost. It might deserve a score of 5. Your second most-important feature might be the size of the reservoir, which may earn it an importance score of 4. Third, you may place modest importance on whether the pump is watertight or not, awarding that feature an importance score of 2.
Next, consider all of your pump options, rating each on the cost, size of the reservoir, and watertightness. Add up each pump’s weighted scores (see Step 3, above) to get their total scores. The pump with the highest total score ranks best when considering all three of your top features.
Pay attention to a pump’s data management software. Some are able to integrate data from other devices (such as CGMs and meters) while others cannot. Many are compatible with both Mac and Windows systems, but not all (and not all work with Windows 8). Talk with your health care provider about how meaningful the software’s generated reports are as well as how easy they are to interpret.
The level at which a pump sounds alarms is important, especially if you’re hard of hearing or spend a lot of time in loud environments. Take prospective pumps for a test drive and pay attention to how loud they sound and how strongly they vibrate.
Keep in Mind
All pumps are well-built and well-supported devices that have a set of core features in common and should serve you well. So if you’ve thoroughly compared devices and still can’t decide among them, go with the one you’re most comfortable with. Worst-case scenario: If you find that you made the wrong choice after you start using the pump, you can return it. Most pump manufacturers offer a 30-day (or longer) money-back guarantee. Check with them when making your purchase to find out the terms.
Nobody wants to walk around looking like a medical cyborg. (Hey, we’re human!) Luckily, several of today’s pumps feature a high degree of discretion—and earn major cool points. As a tubeless patch device, the OmniPod is by far the smallest of all pumps. Tandem pumps are the slimmest and smallest of all tubed pumps. Pumps that can be programmed via remote control (including the OmniPod, Accu-Chek Combo, and OneTouch Ping) allow for the utmost discretion. Of course, you’ll have to weigh the benefit of using a remote control against the drawback of having to carry an extra device around. From a style standpoint, most pumps can be ordered in a variety of colors or with stylish cases.
Easy Does It
Some pumps are simply easier to learn and faster to program than others. Touch-screen technology can help, as can menu-based programming. Be sure to play around. You might find, for instance, that a pump’s lack of a “back” button makes navigation difficult.
Gary Scheiner, MS, CDE, is owner and clinical director of Integrated Diabetes Services, a private practice. He is author of six books, including Think Like A Pancreas, and was named 2014 Diabetes Educator of the Year by the American Association of Diabetes Educators. He has had type 1 diabetes for more than 30 years and has personally worn and trained patients on 28 different models of insulin pumps. You can find more of his pump comparisons at IntegratedDiabetes.com.